Laxatives

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Author:
kvan4741
ID:
105735
Filename:
Laxatives
Updated:
2011-10-02 10:35:26
Tags:
constipation laxatives AMH
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Description:
MOA, brand names, dosing of laxatives/laxative classes per AMH
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  1. stool softeners - agents
    • docusate
    • liquid paraffin
    • poloxamer
  2. stool softeneres - MOA
    • soften stool and ease its passage
    • docusate and poloxamer are detergents (assist with mixing of water into stools)
    • liquid paraffin - lubricant
    • little value as single agents in chronic conditions/major causes
    • indication: prevent straining after rectal sx, acute perianal disease
  3. docusate - dose
    100-150mg D-BD (max 480mg D)

    stool softener

    • take tablets with plenty of fluid
    • onset: 1-3 days po, 5-20 mins rectally
  4. liquid paraffin - dose
    • emulsion 50%:
    • 40mL D (adult)
    • 20mL D (children)
    • adjust dose by 5mL aliquots

    • unemulsified liquid:
    • 120mL rectally

    stool softener

    onset 2-3 days (po), do not take dose immediately before lying down/before bed - risk of aspiration, may reduce abs of fat-sol vitamins (A,D,E,K)

    Agarol (emultion 32%), Parachoc (emulsion 50%)
  5. poloxamer
    • <6 months: 10 drops TDS
    • 6-18 months: 15 drops TDS
    • 18 months - 3 yrs: 25 drops TDS

    • mix with bottle feeds/fruit juice
    • stool softener
    • onset: 2-3 days

    Coloxyl drops
  6. stimulant laxatives - agents
    • senna
    • bisacodyl
    • sodium picosulfate
  7. stimulant laxatives - MOA
    Direct stimulation of nerve endings in gastric mucosa to increase GI motility
  8. bisacodyl
    • 5-15mg N po
    • 10mg once D PRN

    • stimulant
    • swallow tablets whole
    • onset: 6-12 hrs (oral), 15-60 mins (suppository), 5-15 minutes (enema)

    dulcolax, bisalax
  9. senna - dose
    7.5-30mg at bedtime

    • stimulant
    • onset: 6-12 hrs


    • Sennetabs, Senokot (7.5mg)
    • laxettes with senna (12mg)
  10. sodium picosulphate - dose
    • adult, child >10 yrs: 10 drops (5mg) nocte
    • 1 drop = 500mcg

    drop onto spoon or with some water and take stat

    Dulcolax SP drops
  11. osmotic laxatives - agents
    • glycerol
    • lactulose (Actilax, Genlac, Duphalac)
    • polyethylene glycol laxatives (Movicol, ColonLYTELY, Osmolax)
    • saline laxatives (Fleet, Microlax, Picolax, Pico-prep, Epsom salts)
    • sorbitol (Sorbilax)
  12. Glycerol - MOA + dose
    non-absorbable sugar - draws water into faeces, lubricating properties, local irritant = stimulant

    • 1 suppository once D PRN
    • adult - 2.8g
    • child - 1.4g
    • infant - 0.7g
  13. lactulose - MOA + dose
    poorly absorbed - osmotic effect in colon, increase in intraluminal pressure stimulates peristalsis

    hepatic encephalopathy - prevention of ammonia absorption by lowering faecal pH, laxative

    • constipation dose:
    • initially, 15-30mL daily in 1-2 doses (max 60mg D prn)
    • MD: 10-25mL daily

    very sweet - mix with fruit juice, water or milk

    onset 1-3 days

    Genlac, Actilax, Duphalac - 0.67g/mL
  14. Macrogols/polyethylene glycol (PEG) laxatives - MOA + dose
    • large polymers with osmotic activity
    • solutions are iso-osmotic wrt normal intestinal contents = minimises electrolyte and water loss

    • constipation - ColonLYTELY, movicol, Osmolax
    • bowel preparation for sx/dx procedure - glycoprep, glycoprep-C, ColonLYTELY
    • movicol - contains mmol Na+ per sachet - consider risk of hypernatreamia with chronic use
  15. saline laxatives - MOA + dose
    contain poorly absorbed ions, e.g. MgSO4, phosphate and citrate, which retain fluid in the colon through osmosis, stimulating peristalsis

    Constipation: Microlax, Picolax, Epsom salts

    • caution - electrolyte disturbance
    • onset: 30mins - 3 hrs after oral admin
  16. bulking agents - MOA + dose
    • absorb water in the colon to increase faecal bulk, which increases peristaltic activity
    • ADR: flatulence, bloating, abdominal discomfort
    • do not take immediately before bed
    • give with extra fluid
    • dose - according to product label

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